The physicians of the Diabetic Foot Clinic of Western New York have treated
over 280 patients since we began our group practice in July 1996. Many of
these patients have been treated for ulcers lasting over 3 months and had
failed prior attempts to resolve the ulcer before coming to us. Their wound
classification was more often a grade 4 (with osteomyelitis), and previous
studies have demonstrated that these individuals have a 35-45% amputation
Among our 280 patients, 11% required an amputation, including toes.
(Excluding toes, 7.5% of our patients required amputation.) The length of
therapy ranged from 4 weeks to as long as 6 months for some of the more
difficult cases. These amputation rates exclude two patients who, at pre-
sentation, had a non-salvageable foot, with either severe gangrene or severe
infection with non-salvageable circulation. One of the cornerstones of our
success in the treatment of diabetic ulcers that extend to the bone has been
the use of metatarsal head resection to facilitate healing. This allows for the
resolution of the infection and maintenance of the integrity of the foot.
25% of our patients have had recurring ulcers in other locations. This is
equivalent to what has been reported in other studies.2 The amputation rates
for patients with recurring ulcers have been no higher than the original group,
though their times to resolution were prolonged. We are currently analyzing
the data to confirm our perception that the recurrence rate of ulcers has
fallen in the past two years among our patients.
1 NIH Study: Lower Extremity Foot Ulcers and Amputations in Diabetes.
2 Edmunds et al: Improved survival of the diabetic foot: The role of the specialized foot clinic. Quart. J. Med. 60:763-71, 1986.